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Medicare Events
Member ID: 53252345-01
Name: Brown, Sue
Benefit Summary 360
Overrides
COB
Match UM
EOB
Sign Payee
New Medicare Member(Alt + F9)
Relationship:
Wife
Billing Information
Last Bill Date
08/01/2020
Net Amount Due
$1000.00
Current Suspense
$0
Processing Status
Normal Billing
DOB:
01/01/1972
Claims Information
Claim ID
Provider
Begin Date
Status
Total Charge
Claim Type
SubType
130670000100
Smith, Joe
11/10/2022
01 - Acce...
$1000.00
Medical
H
142500000200
Jones, Brian
02/15/2021
15 - Pend...
$200.00
Medical
M
130700000500
Smith, Joe
02/18/2021
11 - Pend...
$350.00
Medical
M
130900000600
Jones, Brian
03/21/2021
11 - Pend...
$250.00
Medical
M
Group:
G1234
Eff. Date:
01/01/2009
External ID:
9896695
Other Family Members:
Yes
Other Family Members
Subscriber
Brown, Tom
Daughter
George-Brown, Mary Ann Elizabeth Isabella Penelope
Son
Brown, John
Medicare
Events
Verifications
Interface
Retiree Subsidy
Carrier/Intermediary
Facilitator
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Event Code
Effective Date
From
Through
Result
Institution ID
Verified By
Date
Method
Reason
ABCDE
01/01/2020
01/01/2020
12/31/2035
1 Requirement Met
MFACILITY - Saint Joseph's Facility
FACETS
10/08/2020
Letter
Lorem Ipsum Doloer
BCDEF
01/01/2020
01/01/2019
12/31/2019
2 Requirement Not Met
MFACILITY - Saint Joseph's Facility
FACETS
10/08/2020
Letter
Address Change
1
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Details
Event:
CRCO Creditable Coverage
CMS Effective:
01/01/2021
Termination:
From:
01/001/2021
Through:
10/01/2021
Result:
Institution ID:
Not Assigned
Verified By:
FACETS
Date:
10/01/2021
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